游离大网膜移植即刻再造乳房7例

Immediate breast reconstruction with free omentum:7 cases

目的利用腔镜下游离大网膜，为luminalA／B1乳腺癌患者探索一个新的乳房再造方法。方法本研究共纳入2015年1—8月在第四军医大学西京医院行保留乳房及腋窝手术和大网膜游离移植乳房再造手术的luminalA／B1乳腺癌患者7例，患者均为女性，年龄33．6±7．7（27—44）岁。术后评价伤口血供、美容效果、并发症以及患者满意度。结果动态氧分压曲线显示皮下氧分压50．17mmHg（1mmHg=0．133kPa），彩色多普勒超声图谱显示血供正常，血流速度为61．29cm／s。术后再造乳房形态自然、手感逼真、双乳对称性良好；伤口恢复良好、位置隐蔽。美容效果Harris评分非常好的有4例，较好的有3例。患者满意度较高。7例患者术后未发现明显并发症，无需二次手术，仅有1例发生轻微血肿，经过临床护理后症状消失。术后中位随访17个月，范围13—20个月，患者未出现局部复发或转移。结论游离大网膜即刻乳房再造为预后较好但不宜保留乳房的luminalA／B1乳腺癌患者成功保留乳房并自体再造，术后效果良好，满意度高，值得推广。

Objective To develop a new oncoplastic volume replacement technique using a laparoscopical]y harvested omentum for luminal A/B1 breast patients. Methods From January to August 2015, 7 patients with luminal A/B1 breast cancer in Xijing Hospital of Fourth Military Medical University underwent breast and axillary conserving surgery and immediate breast reconstruction with free omentum. All patients were females, at the age of 27-44 years [ mean （33.6：1：7.7） years]. The blood supply, cosmetic outcome, complications and patients＇ satisfaction were evaluated after surgery. Results The dynamic oxygen pressure curve revealed that the mean transcutaneous oxygen partial pressure was 50. 17 mmHg （ 1 mmHg = 0. 133 kPa）. Meanwhile, the color Doppler ultrasound demonstrated favorable blood supply with blood flow velocity of 61.29 cm/s. Postoperative observation showed desirable volume and symmetry of the breast, with no obvious scar. Four patients gained excellent results while others achieved good results in Harris scores. All 7 patients were satisfactory with the surgery outcome. No obvious complications occurred except one case of hematoma which was relieved after systematic nursing. Seven patients were followed up for 13-20 months, median 17 months. No local recurrence or metastasis was observed. Conclusion Immediate breast reconstruction using free omentum provides an alternative for luminal A/B1 breast cancer patients who have good prognosis but are unsuitable for breast-conserving, achieving desirable postoperative outcomes and high satisfaction of patients, worthy of clinical application.